Dispute between AOK and family doctors escalates

Bavarian GPs threaten to leave the health insurance system. The AOK Bayern threatens in turn with cuts and also with the withdrawal of the Kassenzulassung.

(04.12.2010) The dispute between the Bavarian Association of General Practitioners and the statutory health insurance companies seems to be getting more and more acute. The general local health insurance AOK has now responded to the threat of the Association of family doctors and in turn reacted with an exclusion warning. Should the medical association continue to urge its members to protest in return for approval as a panel doctor, the AOK will terminate its cooperation with the association. According to a statement by the AOK, the Bavarian Association is requested to withdraw its plans to withdraw the system by 14 January 2011 at the latest. Otherwise, the family doctor contract is already declared one day later by the health insurance company as finished. From the point of view of the health insurances a system exit leads to the danger of the outpatient care in the Free State and is an unjustifiable risk for physicians and patients. The coffers now want to check whether a withdrawal recommendation legally represents a violation of contractual secondary obligations.

Incomprehension of the Bavarian state government
Even the formerly strong support in the Bavarian state government seems to be gradually crumbling. For example, Bavaria's Health Minister Markus Söder (CSU) said on Friday that GPs would have a guarantee by 2014 that the validity of the contracts would continue. The system of statutory health insurance is therefore a wrong way to leave.

Background of the disputes between health insurances and doctors
The background to the conflict is a major event planned for the coming year by the Doctors' Association in Nuremberg. On 26 January 2011, the family doctors' association wants to achieve that as many as possible more than 60 percent of family physicians in Bavaria will return their health insurance license with immediate effect. The association wants to protest with this spectacular action against the health reform of the black and yellow federal government. The main point of criticism is that doctors' fees can not exceed the usual level in the health insurance system for newly concluded family doctor contracts. Although it is also possible for the newly concluded contracts to negotiate higher compensation, but these are associated with clear austerity measures in the health system. Thus, higher fees for primary care physicians are only possible if the difference on so-called efficiency gains and savings elsewhere brought back. Conversely, this means that, for example, physicians should prescribe fewer medicines to patients and reduce hospital admissions.

An exit from the KV system is one „logical consequence of the current legislation“
In the course of the debate on the bill on health care reform, the CSU was still strong for the doctors' fees. Under pressure from the CSU, they had agreed within the coalition to extend the grandfathering of existing GP contracts until 30 June 2014. However, this amendment to the draft law is not enough for the German Association of General Practitioners. You see one in it „attack“ on the medical care of family doctors. The contracts are, according to section 73 b SGB V „almost through the back door“ nullified. The Federal Association stands without compromise behind the resolution of the Bavarian Association. As it was said in a statement: The Federal Association unanimously stands behind the colleagues in the Bavarian family doctors association: Their way to system change is one „logical consequence of the current legislation“ in the health system.

Are the protests legitimate??
A recently published evaluation of the German Association of Health Insurance Funds (GKV) on the average increase in physician fees showed that physician reimbursements increased by 11 percent nationwide between 2007 and 2009. The evaluation has shown that the wages of physicians have increased in the last three years many times more than average wages and salaries in Germany. In Bavaria, however, the fees rose significantly lower than in comparison to the national average. Here, an increase of only 2.6 percent is recorded. According to the Kassenverbandes, a general practitioner with his own practice earns 164,000 euros per year. (Sb)

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Rössler warns physicians against practice closures
Rösler has no sympathy for family doctor protests